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Some Observations on Different Forms of Stupor, and on its occurrence after Acute Mania in Females

Published online by Cambridge University Press:  19 February 2018

H. Hayes Newington
H. Hayes Newington*
Affiliation:
Royal Edinburgh Asylum
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Extract

With the exception of the condition of a person labouring under acute mania, no phase of insanity so thoroughly arrests the attention of even an uneducated observer as that which has been styled stupor in late years. Painful as it is to see the vagaries and extravagances of the former, hardly less so is it to contemplate in the latter the great impairment of mental power, which may reach even to almost total obliteration. But while on the one hand acute mania has been elaborately described from every point of view—indeed, the very nature of its symptoms force a recognition, and demand prompt treatment—yet stupor has received but little attention, considering what an important element it may become in a case. In fact, it is only comparatively recently that it has been looked upon as anything more than mere “depression.” For more than a casual mention of it, we must chiefly refer to French psychological literature, to the writings of such men as Baillarger, Esquirol, Brierre de Boismont, Dagonet, etc. But these authorities differ much in their opinions, even as to the fundamental nature or natures of the sets of mental phenomena which are included under this comprehensive term.

Type
Part I.—Original Articles
Information
Journal of Mental Science , Volume 20 , Issue 91 , October 1874 , pp. 372 - 386
Copyright
Copyright © Royal College of Psychiatrists, 1874

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References

∗ This name has been objected to for various reasons, e.g., that Dementia is essentially incurable, that the condition is not Dementia, etc. There seems to me to be a close analogy between Esquirol's work in this department and Bright's in Renal disease. In both organs experience shows that there may occurist, an acute form of disease with a favourable prognosis, and leaving no immediately apparent mischief behind; and 2nd, a chronic form leaving no hope for cure. And in Dementia, besides, as in kidney disease, there seems a probability that both the acute and chronic forms may have a similar mode of origin, but that the acute form, being a primary disease, and having generally a rapid invasion, lights on a comparatively healthy organ, which, with appropriate treatment, is able to throw it off again; while in the chronic form there is no power of recuperation, and matters can but go from bad to worse.>' href=https://scholar.google.com/scholar?q=This+name+has+been+objected+to+for+various+reasons,+e.g.,+that+Dementia+is+essentially+incurable,+that+the+condition+is+not+Dementia,+etc.+There+seems+to+me+to+be+a+close+analogy+between+Esquirol's+work+in+this+department+and+Bright's+in+Renal+disease.+In+both+organs+experience+shows+that+there+may+occurist,+an+acute+form+of+disease+with+a+favourable+prognosis,+and+leaving+no+immediately+apparent+mischief+behind;+and+2nd,+a+chronic+form+leaving+no+hope+for+cure.+And+in+Dementia,+besides,+as+in+kidney+disease,+there+seems+a+probability+that+both+the+acute+and+chronic+forms+may+have+a+similar+mode+of+origin,+but+that+the+acute+form,+being+a+primary+disease,+and+having+generally+a+rapid+invasion,+lights+on+a+comparatively+healthy+organ,+which,+with+appropriate+treatment,+is+able+to+throw+it+off+again;+while+in+the+chronic+form+there+is+no+power+of+recuperation,+and+matters+can+but+go+from+bad+to+worse.>>Google Scholar

† “Annales Med. Psychol.,” 1872.>>Google Scholar

∗ It was a matter of great difficulty at first to open this patient's mouth with the usual steel expanding gag. Jn addition to violent resistance it was found that she could make her upper jaw so overhang the lower that nothing but the gum of the latter was visible; and again the left condyle of the lower jaw had a tendency to subluxation. (Sir A. Cooper describes a subluxation occurring in young and delicate women, in which the bone returns by itself, as it did on one occasion in this case.) Having noticed that when the nose tube was used, the patient used to collect some spoonfuls of nutriment in her mouth and then spit it out, I hit on the plan of first introducing it, and then lying in wait with the gag at the . She was taken in the first time, but when she had to be fed again she recognised the trick. However, she was in the dilemma of either swallowing by the nose tube (which is the best thing when practicable) or of opening her mouth sufficiently wide to admit of the gag being introduced. Many drugs were introduced with the food, e. g., quinine, opium, tincture of capsicum, and a combination of the last two. None of them eeemed to have any effect.>' href=https://scholar.google.com/scholar?q=It+was+a+matter+of+great+difficulty+at+first+to+open+this+patient's+mouth+with+the+usual+steel+expanding+gag.+Jn+addition+to+violent+resistance+it+was+found+that+she+could+make+her+upper+jaw+so+overhang+the+lower+that+nothing+but+the+gum+of+the+latter+was+visible;+and+again+the+left+condyle+of+the+lower+jaw+had+a+tendency+to+subluxation.+(Sir+A.+Cooper+describes+a+subluxation+occurring+in+young+and+delicate+women,+in+which+the+bone+returns+by+itself,+as+it+did+on+one+occasion+in+this+case.)+Having+noticed+that+when+the+nose+tube+was+used,+the+patient+used+to+collect+some+spoonfuls+of+nutriment+in+her+mouth+and+then+spit+it+out,+I+hit+on+the+plan+of+first+introducing+it,+and+then+lying+in+wait+with+the+gag+at+the+.+She+was+taken+in+the+first+time,+but+when+she+had+to+be+fed+again+she+recognised+the+trick.+However,+she+was+in+the+dilemma+of+either+swallowing+by+the+nose+tube+(which+is+the+best+thing+when+practicable)+or+of+opening+her+mouth+sufficiently+wide+to+admit+of+the+gag+being+introduced.+Many+drugs+were+introduced+with+the+food,+e.+g.,+quinine,+opium,+tincture+of+capsicum,+and+a+combination+of+the+last+two.+None+of+them+eeemed+to+have+any+effect.>>Google Scholar

∗ Since this was written, three montila ago, this patient lias not improved. A few days ago she menstruated for the first time. This was preceded by a slight improvement, accompanied by considerable irritation, and followed by a relapse. It seems now to be a hopeless case.>>Google Scholar

∗ She was discharged cured, and and after being two and a half months out has lately como back in a state of acute mania.>>Google Scholar

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